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<div align="center">   <h1>广州京诚检测技术有限公司</h1>
<h2>委 托 检 验 协 议 书 （环境类）</h2>
</div>


<table width="780px" border="1" align="center" cellpadding="0"
		cellspacing="0" bordercolor="#E2E2E1" bgcolor="#FFFFFF">
	<tr>
	<td align="left" colspan="4">说明：1. 需要出英文报告的，请详细填写英文单位名称、英文地址、英文样品名称；<br/>
&nbsp;&nbsp;&nbsp;&nbsp;2. 带有 * 标识的为必填内容。</td>
	</tr>
	<tr >
	<td rowspan="5" width="30%">委托单位信息</td>
	<td colspan="3">*单位名称：</td>
	</tr>
   <tr >
	<td colspan="3">*报告抬头：</td>
	</tr>
	<tr >
	<td colspan="3">*发票抬头：</td>
	</tr>
	<tr >
	<td colspan="2">*通讯地址（邮政编码）：</td>
	<td>E-mail：</td>
	</tr>
	<tr >
	<td>*联系人：</td>
	<td>*电话：</td>
	<td>传真：</td>
	</tr>
	</table>
	<table width="780px" border="1" align="center" cellpadding="0"
		cellspacing="0" bordercolor="#E2E2E1" bgcolor="#FFFFFF">
		<tr >
	<td rowspan="5" width="30%">样品信息</td>
	<td >*样品名称：</td>
	<td >*样品数量：</td>
	</tr>
   <tr >
	<td >样品来源：</td>
	<td>规格：</td>
	</tr>
	<tr >
	<td colspan="2">样品类别：</td>
	</tr>
	<tr >
	<td colspan="2">存放要求：</td>
	</tr>
	<tr >
	<td colspan="2">采样日期及采样时
周边环境简单描述
：</td>
	</tr>
</table>
<table width="780px" border="1" align="center" cellpadding="0"
		cellspacing="0" bordercolor="#E2E2E1" bgcolor="#FFFFFF">
		<tr >
	<td rowspan="2" width="30%">委托内容</td>
	<td >*检验项目：</td>
	<td >*检验依据：</td>
	</tr>
   <tr >
	<td colspan="2">检验目的：</td>
	</tr>
</table>
<table width="780px" border="1" align="center" cellpadding="0"
		cellspacing="0" bordercolor="#E2E2E1" bgcolor="#FFFFFF">
		<tr >
	<td rowspan="2" width="30%">报告交付</td>
	<td colspan="2">*交付方式</td>
	</tr>
   <tr >
	<td >*报告份数</td>
	<td >交付日期</td>
	</tr>
	 <tr >
	<td >样品处理
</td>
	<td >
</td>
	</tr>
		<tr >
	<td rowspan="2" width="30%">检测费用
</td>
	<td >*检测费（元）</td>
	<td >加急费（元）</td>
	</tr>
   <tr >
	<td >*合  计（元）</td>
	<td >预收费（元）</td>
	</tr>
	<tr >
	<td>备注</td>
	<td ></td>
	</tr>
</table>
<table width="780px" border="1" align="center" cellpadding="0"
		cellspacing="0" bordercolor="#E2E2E1" bgcolor="#FFFFFF">
		<tr>
		<td>*委托人签字：</td>
		<td>*受理人签字：</td>
		</tr>
		</table>
		<div align="center">地址：广州市番禺节能科技园天安科技创新大厦413(511400)             网址：http://www.beijingtest.com<br/>
联系电话：（020）39211288           传真：（020）39211233           E-mail：cs@beijingtest.com
       
业务员：                 
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